There is a significant problem with patients' failing to follow a medical practitioners post-examination treatment instructions. The terminology we use for this is compliance. While the patient may choose to consciously ignore medically necessary advice, the greater problem is with patients who leave the medical practitioners office without being sufficiently cognizant of the diagnosis or prepared to follow the recommended therapeutic intervention. This long recognized problem has been intractable, defying easy solution, but which can now be addressed due to advances in telecommunications and computer technology. An associated problem is that health care practitioners often fail to comply with existing ever-changing treatment guidelines.
Our awareness of the problem arises in part from experience with Diabetes. Diabetes Mellitus is the fourth leading cause of death in the United States and a major cause of blindness and heart disease. It is the major cause of blindness in person's 24-74 years of age, with 39,000 new cases each year. Ten percent of patients with diabetes develop renal disease. Patients with Type-2 diabetes have a 28-fold increased risk of limb amputation, and approximately 50% of people with diabetes for 25 years have evidence of neuropathy. Diabetes imposes a 2 to 4-fold lifetime risk of heart disease, and a 5-fold lifetime risk of a stroke.
Often, even physicians do not comply with the American Diabetes Association (ADA) standards of practice. The ADA publishes standards of practice for comprehensive care of Type-2 Diabetes Mellitus (DM), including guidelines for optimizing glycemic control. It is well documented that physicians and other health care providers often do not comply with the existing ADA guidelines. And even when the health care provider strictly adheres to the recommended disease specific intervention, the patient is likely to depart from the recommended therapy either through neglect or misunderstanding. There is a clear need for a system that will assist both the patient and health care practitioner adhere to recommended therapeutic guidelines. We believe that the proposed system will enhance the treatment process and outcome of disease management for diabetic patients and patients with other diseases.
Patients may fail to accurately follow doctor's order for a variety of reasons. All to often they leave the medical encounter without a clear understanding of the diagnosis or recommended course of action. Being ill is traumatic—and under the pressures of a medical examination, patients are often unable to focus on the instructions for treatment. They may have difficulty understanding the medical terminology. There is a cognitive difficulty in remembering instructions for complicated regimens. The age of the patient or the national origin of the patient or doctor may be a factor. Older patients may simply have hearing problems. As simple a distraction as children in the examination room or a loud air conditioner may make verbal communications difficult.
For whatever reason, the ability of patients to leave a medical encounter fully cognizant of the information they need to continue care is a real problem with serious medical consequences. The purpose of this system is to significantly assist patients in their compliance to the post-visit medical care instructions that arise from a visit to a doctor.
The current means to address the problem primarily rely on pamphlets and/or packets of printed information appropriate to the patient's complaint that is used to supplement the practitioner's verbal instructions. For instance, lower back pain is a common complaint, and doctors will often provide patients with a booklet describing the problem and the appropriate exercise treatments.
While this has been helpful the approach has serious problems. The information can only be maintained on a limited number of the most common complaints, and may not be in the native language of the patient. Supplies of pamphlets may run out, and more recent medical advances and treatment guidelines may easily outdate the information. HMO's and large managed care practices are beginning to issue medical information books to members that explain the diagnosis, treatment and prognosis for the most common ailments. Unlike pamphlets provided to the patient during a medical visit and addressing the specific patient complaint, these books are entirely general, and may easily become out-of-date, and may be lost or otherwise unavailable to the patient. Another problem with this approach is that it only provides general information that is meant to supplement the practitioners instructions, but does nothing to assist the patient with the specific instructions deemed appropriate to their situation.